Health Quality BC (HQBC) recently revealed the recipients for the 2025 BC Quality Awards: An annual recognition of the people and projects finding solutions to health-care challenges and improving the quality of care in the province.
Kudos to Valeria Stoynova, MD (pictured left) and Celia Culley, PharmD (right), leads on the Critical Air Project, which has received an award in the "Achievement in Sustainable Health Care" category. Learn more about the project below.
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Critical Air Project Overview
Climate change is a major health challenge, yet health care itself is a significant contributor to greenhouse gas emissions (GHGe). Pharmaceuticals account for a quarter of this, and inhalers, particularly metered-dose inhalers (MDIs), stand out for their environmental impact. MDIs rely on hydrofluoroalkane propellants, potent greenhouse gases, and each MDI can have a carbon footprint comparable to driving 170 km in a typical gas-powered car. Nationally, MDIs contribute 3.5% of health care system emissions.
Valeria Stoynova (MD) and Celia Culley (PharmD) are revolutionizing climate-conscious medication management through the Critical Air Project. Culley and Stoynova created the project with the vision triple aim to make a meaningful, measurable impact on health care related GHGe, while maintaining high quality inpatient patient care, and decreasing health care costs by tackling inhaler-related carbon footprint through an evidence-based, patient-centered quality improvement approach focusing on three prongs:
Policy Changes:
- Advocating for updates to hospital formulary to include low carbon inhaler alternatives.
- Advocating for provincial purchasing contracts to include environmental impact as part of the decision-making process for salbutamol MDIs.
- Initiating the development of policies and procedures to safely send patients home with already dispensed multidose medications (such as inhalers) at discharge.
- Advocacy to change provincial guidelines to include a planetary health lens to respiratory disease care.
Operational Changes:
- Optimization of the inhaler tamper seal location to reduce waste of unused inhalers.
- Optimization of inhalers available as ward stock to reduce duplicate dispensing.
- Redesign of clinical order sets to promote carbon stewardship when ordering inhalers.
- Optimization of inhaler transfer process to avoid loss.
Educational Campaign:
- Developing playbooks, collateral, and multidisciplinary resources, and providing presentations for health professionals to scale impact.
The groundwork for the project has been laid over the last three years. Drs. Culley and Stoynova are still actively involved in the implementation and measurement of change ideas. Their innovation has already led to meaningful change.
Ivy Lam, Pharmacy Innovation Lead, “Creating a Sustainable Canadian Health System in a Climate Crisis" shared that “Drs. Stoynova and Culley's Critical Air Project has prompted important educational, operational, and policy interventions to improve the sustainability of inhaler practices at Island Health and serves as a blueprint for health care providers across Canada interested in undertaking similar efforts."
By addressing the climate crisis through actionable interventions, the Critical Air Project exemplifies the future of sustainable health care systems in Canada.
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This year, four Island Health initiatives received BC Quality Awards for their outstanding contributions.
Winners are awarded a sponsorship for ongoing development and/or to help support and disseminate learning from their projects, and are also invited to attend the Quality Forum, HQBC's annual conference.
Join us in congratulating Drs. Valeria Stoynova and Celia Culley, and in celebrating their incredible accomplishment!